Cordova Community Medical Center
Community Health Needs Assessment and
Key Informant Interview Findings
December 2016
525 S. Lake Avenue, Suite 320 │ Duluth, Minnesota 55802
218-727-9390 │ [email protected]
Get to know us better: www.ruralcenter.org
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TABLE OF CONTENTS
Introduction .................................................................................................. 2
Survey Findings ............................................................................................. 3
Key Informant interviews .............................................................................. 10
Conclusions, Recommendations, and Acknowledgements .................................. 10
Establishing Health Priorities ......................................................................... 22
Improving Population Health in Your Community .............................................. 23
Population Health Critical Access Hospital Case Studies ..................................... 26
APPENDIX A: Survey Instrument.................................................................... 28
APPENDIX B: Survey “Other” Comments ......................................................... 31
APPENDIX C: Key Informant Invitation and Questions ...................................... 34
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INTRODUCTION
Cordova Community Medical Center (CCMC) participated in community health
needs assessment services, administrated by the National Rural Health Resource
Center (The Center) of Duluth, Minnesota.
In the winter of 2016, The Center conferred with leaders from CCMC to discuss the
objectives of a regional community health needs assessment. A mailed survey
instrument was developed to assess the health care needs and preferences in the
service area. The survey instrument was designed to be easily completed by
respondents. Responses were electronically scanned to maximize accuracy. The
survey was designed to assemble information from local residents regarding:
Demographics of respondents
Utilization and perception of local health services
Perception of community health
Sampling
CCMC provided The Center with a list of inpatient hospital admissions. Five hundred
fifteen residents were selected randomly from PrimeNet Data Source, a marketing
organization. Although the survey samples were proportionately selected, actual
surveys returned from the area varied. This may result in slightly less proportional
results.
Survey Implementation
In November, 2016, the community health needs assessment, a cover letter with
CCMC’s letterhead and a postage paid reply envelope were mailed first class to 515
randomly selected residents in the targeted region (one zip code). A press release
was sent to local newspapers prior to the survey distribution announcing that CCMC
would conduct a community health needs assessment throughout the region, in
cooperation with The Center.
One hundred twelve (112) of the mailed surveys were returned, providing a 24%
response rate. Based on the sample size, surveyors are 95% confident that the
responses are representative of the service area population, with a margin of error
of 6.89. Note that 55 of the original 515 surveys sent were returned by the U.S.
Postal Service as undeliverable.
This report includes comparisons to averages from The Center’s overall community
health needs assessment database (CHNA Database) where applicable. Please note,
sample sizes are different for each community, but are comparable.
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Recommendations are included for developing and implementing program plans to
address key health issues identified by the community. A copy of the survey
instrument is included at the end of the report (Appendix A).
Report Findings May be Used For:
Developing and implementing plans to address key issues as required by the
Patient Protection and Affordable Care Act §9007 for 501(c)3 charitable
hospitals
Promoting collaboration and partnerships within the community or region
Supporting community-based strategic planning
Writing grants to support the community’s engagement with local health care
services
Educating groups about emerging issues and community priorities
Supporting community advocacy or policy development
Survey Findings
The Center has been administering CHNAs in rural communities across America for
over 25 years, which enables historical and comparative analysis if applicable.
Comparative analysis from the CHNA Database is included when questions, field
selections and methodology are standardized.
In the following tables and graphs, the question asked on the mailed survey is
emboldened and the question number from the mailed survey is appropriately
labeled as “Q4”.
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Community Health
Q1: How would you rate the general health of our community? Based on The
Center’s CHNA Database, 40% of respondents rate their community as “Healthy”
and 42% as “Somewhat Healthy”. (N=112)
Perception of Community Health
No
Answer
Very
Healthy Healthy Somewhat Healthy Unhealthy
Very
Unhealthy
5%
n=6
6%
n=7
29%
n=32
55%
n=62
4%
n=4
1%
n=1
Q2: What are the three most pressing health concerns in the community?
Respondents were asked to select three that apply, so totals do not equal 100%.
(N=112)
Health Concerns n= 2016
Substance abuse 57 51%
Alcohol abuse 54 48%
Access to specialists 43 38%
Affordable health care 35 31%
Prenatal labor & delivery 29 26%
Prescription drug affordability 19 17%
Chronic disease management (diabetes, heart failure) 15 13%
Obesity 14 13%
Healthy lifestyles (exercise/nutrition) 13 12%
Cancer 12 11%
Geriatric care (seniors) 12 11%
Mental health services 11 10%
Heart disease/stroke 7 6%
Smoking 6 5%
Access to primary care 5 4%
End-of-life care 5 4%
Wellness/prevention services 5 4%
Other 5 4%
Ability to service different languages/cultures 4 4%
Dental services 4 4%
Asthma 1 1%
Reliable health information 1 1%
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Your County’s Top Health Concerns
Source: Accessed through Community Commons
US Census Bureau, 2010-14 CDC and Prevention, 2006-2012 HRSA, 2006-2010
American Community Survey. Behavioral Risk Factor Surveillance System Area Health Resource File
Meeting Community Health Needs
Q5: What can Cordova Community Medical Center do to best meet the
health needs of our community? This was an open ended question where
respondents were able to write in any answer they wanted. The top answer topics
are listed below. See the full list of answers in Appendix B. (n=82)
Staffing (25)
Reduce Cost (15)
Education (10)
Specialist Care (10)
Labor and delivery services (7)
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Q3: What is the greatest health education need in our community?
Respondents feel the need for “Mental health/substance abuse education” and
“Health screenings”. (N=112)
Health Education Needs n= 2016
Mental health/substance abuse education 38 34%
Health screenings 23 21%
Healthy lifestyles education 16 14%
Disease specific information 12 11%
Obesity prevention 7 6%
No Answer 6 5%
Tobacco prevention & cessation 4 4%
Oral/dental health education 2 2%
Reproductive health education 2 2%
Other 2 2%
Q4: What is your preferred method to receive education on health issues
through Cordova Community Medical Center (CCMC)? Community classes are
the most frequently cited mode for receiving health education, according to
respondents. Respondents were asked to select all that apply, so totals do not
equal 100%. (n=111)
Preferred Method of Learning n= 2016
Classes in the community 57 51%
Pamphlets or other printed materials 42 38%
CCMC website 32 29%
Facebook/social media 32 29%
Newspaper 28 25%
Radio 24 22%
GCI Scanner 18 16%
Other 2 2%
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Routine Care
Q6: Where are you most likely to go for routine health care? The majority of
respondents are most likely to go to a physician’s office for routine health care.
(N=112)
Reason for Selecting the Primary Care Provider
Q7: If you use primary care outside of CCMC, why? The top response,
according to The Center’s CHNA Database, is “Closest to home”. Respondents were
asked to select all that apply, so totals do not equal 100%. (n=100)
Reason for Selecting Provider n= 2016
Prior relationship with other provider 34 34%
Other 22 22%
Cost of care 20 20%
N/A I always receive care at CCMC 19 19%
More privacy 18 18%
Quality of staff elsewhere 15 15%
Quality of equipment elsewhere 14 14%
Required by insurance plan 11 11%
Closest to home 4 4%
VA/Military requirement 4 4%
Closest to work 1 1%
39%
(n=44)34%
(n=38)
12%
(n=13)
12%
(n=13)4% (n=4)
CCMC physician’s
office
Ilanka Clinic N/A; I do not
receive routine
health care
Outside of
Cordova
No Answer
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Rate Primary Care Services
Q9: Please rate the effectiveness of health care services at CCMC on a scale
of 1-4. Non-numerical selections were eliminated and the sums of the average
weighted scores were calculated. The total average weighted score was 3.15,
indicating the overall effectiveness of services as “Good”. (N=112)
Rate PC Services
(N=159)
Average
Weighted
Score
No
Answer
Excellent
4
Good
3
Fair
2
Poor
1
Not
Applicable
Referring me to other
providers when
appropriate
3.30 12 26 38 7 4 25
Level of compassion
shown for my health 3.21 9 19 48 15 4 17
Overall care 3.15 10 16 33 16 5 32
Emergency room care 3.15 7 39 36 14 3 13
Communication with my
providers 2.95 8 34 26 9 2 33
Communication between
my providers 2.86 9 31 47 13 2 10
Average weighted
Score 3.15
3.30
3.21
3.15
3.15
2.95
2.86
Referring me to other providers when…
Level of compassion shown for my health
Overall care
Emergency room care
Communication with my providers
Communication between my providers
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Greatest Specialty Need
Q10: What type of specialist would you like to have access to most in our
community? Respondents would most like to have access to an
Obstetrics/Gynecology specialist. This was also requested through key informant
interviews. (N=112)
Requested Specialist n= 2016
Obstetrics/Gynecology 24 21%
No Answer 15 13%
General surgery 12 11%
Cardiology 11 10%
Ear, nose & throat 11 10%
Chronic acute pain 8 7%
Orthopedics 7 6%
Other 5 4%
Dermatology 4 4%
Psychiatric services 4 4%
Endocrinology/diabetes 3 3%
Urology 3 3%
Ophthalmology 2 2%
Rheumatology 2 2%
Podiatry 1 1%
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KEY INFORMANT INTERVIEWS
Introduction
The National Rural Health Resource Center (The Center) of Duluth, Minnesota was
contracted by Cordova Community Medical Center to conduct key informant
interviews to provide qualitative data on the strengths and needs of local health
care services.
Key Informant Methodology
Seven key informant interviews were scheduled in November and December, 2016.
Key informants were identified as individuals who provide leadership in the
community. Invitations were mailed for the surveyor to call the key informant. Key
informants received the list of questions attached (Appendix C) prior to the call.
Each key informant session was approximately 30 minutes in length and included
the same types of questions. The questions and discussions were led by Kami
Norland and Sally Buck of The Center.
Key Informant Findings
1. Describe the overall health of this community.
Alcohol/Substance Misuse
“There is a heroin epidemic here”
Fair amount of drug and substance abuse – alcohol, smoking, meth and
opioid use
Alcoholism is an issue and we have a drug problem (heroin and crystal
meth)
Recreational use of marijuana
Two classes of people in town; those who exercise and get outside and
substance abusers
Health Concerns
Not overly healthy – a lot smoking and obesity
It’s not an overly active community
It’s pretty good; I don’t go to the doctor often because I’m health
conscious
Location/Population
Good, but there are issues with living in a remote location
There is a large transient population with specific health issues such as
trauma, alcohol and drugs
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We’re off the road, the only way in is by plane or boat and those that
have severe health concerns move, so those that are healthy, stick
around with the exception of some with more chronic diseases
There is choice in providers with a female/male, 2 clinics, and a dentist
and a behavioral health/cd services= great access to care given the size
of the town
Two communities in Cordova – Native village of Eyak and citizens of
Cordova – served by both clinics
Cordova is a fairly health town with a younger population that fishes,
there are some older folks that have lived here for generations, there are
also transients here where the population doubles in the summer
The local grocery store sells organic food and there is a need/desire for
these products
Overall Health Concerns
Aging population
Kidney and cardio vascular diseases
Some people are able to do kidney dialysis at home which is nice
2. What is the greatest health need in the community?
Lack of Access to Specialty Services
Having to travel away for care is really hard for the individual and their
family member
Having the entire health system of services available for the community
Cancer is highly prevalent but we can’t meet the needs of these patients
without their having to travel to Anchorage or Seattle, it would be nice to
have oncology services available locally
There is no specialty care available, especially OBGYN, no eye care, no
surgeon
“It would be much more convenient to birth babies locally as families
have to leave for Anchorage one month ahead of their due date and find a
place to live; which is expensive and challenging”
Not having the ability to do more emergency medicine and surgery
Having access to a surgeon would be really nice; we must travel to
Anchorage for emergency surgeries such as an appendectomy or fractures
No home health here which would be very beneficial
Having the ability to do screenings; mammography, MRI, colonoscopies
Reduce Medi-vac procedures
Preventative care
Emergency care
Health Education
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“General health is a need everywhere and we have these services, but we
need to work on the addiction of opioid and illicit drugs- how do we
combat these needs?”
“We have mental health and substance use: sound alternatives; but how
can these partnerships be fostered further to better help the needs of the
community?”
3. What do you think CCMC could do to increase the health of the
community? Where are the opportunities to collaborate?
Reduce Duplication of Services in Town
“Collaborate with the other clinic as they see the majority of patients in
town. CCMC might be a more viable option over the other clinic because of
the hospital based care”
“CCMC should be stronger and better for the community”
“There is a lab at both clinics in town; the difference being that NVE accepts
all patients and offers a sliding fee scale; so CCMC could focus on hospital
services rather than primary care”
Behavioral health offered at both sites. Maybe there is a way to collaborate
on behavioral health for state funds (CCMC) and federal funds at NVE?
“Merge primary care clinics to save funds? Although there are cultural
impediments to overcome. Especially in the winter.
There is an opportunity for both the clinics in town to collaborate but they
will need to overcome past issues. Formerly they were co-located.
Enhance Collaborations
Collaborate with public health
Collaborate with employers
Collaborate more with the mental health agency, family resource center
and substance abuse program
Collaborate more with Sound Alternatives
Collaboration with others is needed
Outreach and Education
Increase awareness of services through outreach and education, starting
with longer organizations – city, electric, forestry, fish processing plant, etc.
Encourage local utilization and promote staff capabilities
Increase general education with the community – expand health fairs
One of the doctors is doing monthly information programs in the evenings
(diabetes for example) and this is really important and I’d like to see this
expand and continue
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Create an approach to benefit the whole community and others that can
benefit
Be sure to provide services to the Philippine population; these seasonal
employees are important too
Education on services available; we’ve done this already but we need to
keep doing this in different ways
Internal Processes
Improve operations, improve energy efficiency, lease out space
The hospital has a good facility and it is clean, but they have limited funds
Community has concern about quality of care; reputation was poor past
decade
Need to improve the quality and promote the services
“Having two full – time physicians living in the community is helpful, but
I’m not sure if everyone knows about them yet?”
We have 2 permanent physicians now which has really helped
They’re doing a good job; new providers are doing great; health fair is fun
and a big deal; do the health fair in the fall too to be more accessible for
other’s schedules
Have a nurse oversee tele-medicine services?
Provide more skilled nursing, don’t separate the nursing home
4. In your opinion, what are some of the strengths (availability, quality)
of the health services offered at CCMC?
Staff and Leadership
Physicians are a strength – family medicine. One was in military with
emergency experience. Dedicated to improving care
Staff are dedicated – four doctorate level beyond physicians, smart and
talented
Two doctors available – male and female for primary care not just
emergency
Staff seems to get along well
Staff is friendly and new CEO is great, physicians are good
CEO is now meeting with FQHC monthly, trying to rebuild cooperation
Working on collaboration with NVE – new leadership in both organizations
Two very new doctors; one male, one female to help treat people in their
own comfort zone, very good paramedics and EMS services, close working
relationship with staff
Good people working here
Staff are part of the community, so you’re getting treated by a friendly
person
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Nursing care is excellent and is a draw from other towns
Services are good by physicians and nurses
Quality of care is good
Care at the hospital was good and responsive to needs
Services
Radiology – x-ray, long term care facilities, certified lab, emergency room
– admit or triage and Medi-Vac are all excellent
24-hour emergency services
“It is good to have a CT scan for stroke care locally”
Large facility, centrally located, good suite of services
Good access to care where appointments are available
Good coordination between hospital and pharmacy
Triage quickly for life flight
Communication with Anchorage hospital is effective, but paper work may
be a day late which can put a snag in communication a bit, but diagnosis
and lab communication is good; with EHR, care has improved
“Behavioral health counseling is located at the clinic which is great”
Hospital has laboratory and imaging
“Hospital has decent lab, CT scan, x-ray services”
Telehealth for behavioral health is helpful
More available than any other services, appointments are easy to get day
of, emergency care is open 24-7 is available; 10-15 minute wait for ER
care
“Quality of care for general care is excellent; specialty services are not
always available, no baby deliveries, no surgeries, some specialty clinical
services come in, but it’s hard to know when they come and to coordinate
schedules to meet their availability”
Billing timing is chaotic, won’t get bill until 3-8 months later sometimes,
bills are accurate
Billing process is much better now as it is more prompt now
Lab tests and medical tests come through very well
Convenience
ER is good and they’ve been able to manage/stabilize complex trauma
situations
Clinic is not to the point of utilizing their EHR as advanced as the CHC in
town
Health fairs are great
Sport physicals are great
Senior lunches are wonderful
Meals and wheels are great
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5. In your opinion, what are some of the barriers of the health services
available at CCMC?
Lack of Access to Services
Don’t have MRI and specialists
“It’s a two or three -day trip to see specialists or get diagnostics done
and you have to take the ferry or jet flight; which can be challenging
with weather issues”
“Lack of an ICU”
“I have a choice of care and CCMC is not my first choice, wouldn’t go
there myself due to the lack of specialty services and getting referred
out anyways”
Deliveries (OB) have to happen in Anchorage – issues – leave
employment for a month before due date. Families are separated.
“Pre-natal care and deliveries are provided outside Cordova which is
expensive to set up household arrangements in Anchorage for a month’
It’s challenging to plan ahead to see a specialist either locally or in
Anchorage, then it’s also challenging to travel when you’re not feeling
well
Lack of access to specialty services
Imaging – CT scan and x-ray
Lack of population to support all typical services available in health care
and break even
Low volume for services, maintaining staff and skills and quality with
duplication of services
Being geographically remote and off the road system. All transfers by air
or ferry
Not aware of CCMC using telehealth
Might be perception of low quality and need for outreach
Access to psychiatric services
Inpatient psychiatric services are sent to anchorage
Lack of access to psychiatric services via tele-med
Internal Processes
“Departments don’t seem to talk to each other; there is a lack of
procedures and communications”
“Long -term care patients not always monitored closely”
Paperwork process is not streamlined at ED or registration
“Seems like staff aren’t happy with EHR. Staff turnover and locum
tenens don’t know procedures. Not friendly to NVE patients”
“Food services aren’t meeting patient requests and comes late for the
long term care residents”
“Continuity of providers and trust in service and quality”
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“Typically, no permanent nurses or physicians has challenged CCMC’s
reputation which impacted quality of care; although they are working
towards permanent staff and continuity of care”
Confidentiality in small community for behavioral health
Two clinics: the native clinic has split the community and my doctor got
run out of town so I followed her; this hindered the community with
access to the clinic due to its “good ol’ boys club” mentality
“With past turnover, I’m less likely to establish a relationship with a
CCMC provider now”
With past turnover, less likely to establish with provider
Cost of Care
Cost; low volume and scope for specialties and surgery
Cost of connections – must have redundancy in broad band for internet
– fiber and microwave radio backup ($80,000/month)
Issues with uncompensated care; Medicaid expansion – has actually
caused bad debt to go up with high health deductibles.
Medi-Vac is costly
Economics – low volume and far from other specialists
Finances are a barrier for some
clinic has competition from IHS that can offer a sliding scale which is
beneficial for the community, Clinic offers community benefit for some
Financial situation is a closed market- small market to generate
revenue, need to push swing beds
6. What new health care services would you like to see available locally?
OB/GYN
Pediatrician
Birthing facilities and providers
Delivery services
Previously C-Sections were performed locally
Operating Room put back together (currently a meeting space
“Don’t Medi-Vac all patients”
Perhaps telemedicine
Not aware of all that is available
Physical therapy if not available
Occupational health
Health screenings if not available
Ophthalmology
Dermatology
Expand primary care services
Level 4 Trauma designation
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Maybe population health – chronic disease management services
Potentially more telehealth services
“There’s a lot of pilots in the area, so I’d like to see more specialty clinic
that could do aviation physicals more than once a year (every 3
months); plan this out and let people know ahead of time so they can
plan with the FAA”
Specialty clinic like internal medicine, endocrinologist, orthopedics, work
with other clinics to network care
Cancer- oncology services
There’s services available, I just don’t need them at this time
7. Why might people leave Cordova for health care?
OB not available
Ultrasound and sonograms now available locally
Orthopedics, urology, and other non-primary care services are not
available
NVE is offering eye care quarterly
Only one dentist locally – many go to Anchorage.
Perceived quality and availability of services
Some Veterans leave for care at VA – Anchorage
Perceived quality – bigger is better
Confidentially
Services not available such as specialists (2)
Specialty care (maternity, delivery) services that are not offered
Limited dental access and low perception of quality
Personality conflict with a provider
Second opinion
“40% of people don’t get primary care locally according a previous
study, so people are leaving for care to go shopping and receive
specialty care in anchorage”
You get more of a choice of health care if you go elsewhere
Distrust
People follow doctors when they leave town
8. What are some of the benefits of having health services available
locally?
Convenience
Peace of mind
Safety net for commercial fishing industry
Convenience
No wait lines in the ER room
You don’t have to travel
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You get to see your provider on a more regular basis
It’s easier to get in; no wait time
Access to care is very good
People are more apt to get care if care is available
Don’t have the expense of living away from home
Community Impact
Provides stability for the community
Allows for Coast Guard base to be there and other businesses
Coast Guard here because of hospital and clinic
“Get primary care locally, get triaged and Med-Vac. People are able to
stay in the community who live here as there is an ED and primary care”
Fishing industry is dangerous – important to have emergency services
available locally
Attracting and retaining employees to Cordova – ask about health
services and schools. Health services are an asset
Elderly and retirees are attracted to stay due to hospitals
Immediate access for primary care and ED
Geographic remoteness – sometimes limited by weather and CCMC
provides services locally. (Ferry runs 4 days a week in winter 3-7 hours
and 45-minute flight – two a day)
Access to Care
Long term care services – stay in Cordova locally
Access – know the doctor and staff
Access to emergency care
Work with both Providence and the other hospital in Anchorage
People in Cordova are very outdoorsy and if you have an accident, you
have access to an ER to help stabilize then refer back
Other Comments
High fixed costs, so better utilization will help with sustainability
Collaboration is important to share services and costs
Increased outreach for marketing and utilization
Lots of opportunities for health care, but we’re limited with location and
a small population
“There are a lot of unknowns right now in the direction of healthcare
from a federal standpoint given our new administration, so I’d like to
assure that CCMC has a safe, strategic plan to navigate whatever comes
about from federal regulation changes”
“There is a lot of paper work involved in the new quality reporting
requirements that take up a lot of time and can be burdensome to staff;
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it would be great to find a way to streamline these reporting processes
and requirements while still maintaining high quality care standards”
Behavioral health was more involved in long term care folks previously,
which was very nice; behavioral health assessments were provided in
the ER; it would be nice to get nurses more trained on behavioral health
issues
“Getting other doctors credentialed here is a biggie”
Collaborate a lot more with the native community: build the relationship
back with them; the city and the hospital have been at odds with the
tribe so the tribe doesn’t trust them now, so they need to build trust
back
One thing the hospital needs to do is have some greater sustainability
with the CEO position; there have been 9 CEOs in 6.5 years so about
the time the CEO gets to doing anything, the health services board/city
council changes the CEO- which seems to be mainly due to political
reasons; however despite the changes in CEO leadership as well as the
CFO and DON positions, the quality of care appears to have remained
consistent throughout each transition and overall, morale is positive
amongst staff
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CONCLUSIONS, RECOMMENDATIONS, AND ACKNOWLEDGEMENTS
Conclusions
Respondents rate the community as “somewhat healthy” with substance and
alcohol abuse rated as a top health need. Education on mental health and
substance abuse services through community classes was requested. Access to
specialty care services, in particularly OB/GYN and birthing services was frequently
identified from both the survey and key informant interviews. Respondents perceive
the quality of care at CCMC as “good” and acknowledge that services and
reputation are improving.
Recommendations
Noting the changes in health care reimbursement structures, hospitals will begin to
be reimbursed based on the population’s health outcomes. This transformation is
changing the definition of hospital volume from the number of procedures and
interventions to the number of patients being seen in the service area. Capture a
greater market share by expanding efforts towards individuals that are currently
healthy and not currently utilizing local health services by engaging the community
in prevention/wellness activities and health education. Providers and the board
should also be educated on this transition as it is imperative for future sustainability
and viability of each organization.
It is also recommended each facility increase efforts on role modeling wellness and
expanding collaborative community partnerships to improve the overall
coordination of care for patients. Reference the section below on “Improving
Population Health in Your Community”, as cited below.
There is also an opportunity to improve customer processes and perception of
quality care by implementing management frameworks such as Baldrige, the
Balanced Scorecard, Lean and/or Studer methodologies. These frameworks
evaluate and monitor the effectiveness and efficiencies of staff processes, manage
ongoing performance improvement, and help create a positive work culture that
can result in greater staff and patient satisfaction. Please contact The Center for
more information and guidance on these services or go to www.ruralcenter.org for
further details. Focus groups also indicated a high burnout rate of providers and so
consider resiliency training for all staff to assist with retention and improve overall
quality and morale.
Share results and communicate proposed strategies that address community needs
as this will promote customer loyalty. It is advised to create a communications
strategy for releasing the report findings. It is important to be clear on the intent of
these communications (e.g., to share information or to stimulate action).
NATIONAL RURAL HEALTH RESOURCE CENTER 21
Acknowledgements
The Center would like to thank Mr. Scot Mitchell and Faith Wheeler-Jeppson for
their contributions and work with developing and distributing the assessment and
coordinating the key informant interviews.
NATIONAL RURAL HEALTH RESOURCE CENTER 22
ESTABLISHING HEALTH PRIORITIES
Sufficient resources frequently are not available to address all the health concerns
identified in a Community Health Needs Assessment. Identify issues to work on in
the short to intermediate term (one to three years). Priorities should reflect the
values and criteria agreed upon by the hospital board and community stakeholders,
which should include public health.
Criteria that can be used to identify the most significant health priorities include:
The magnitude of the health concern
(the number of people or the percentage of population impacted)
The severity of the problem
(the degree to which health status is worse than the state or national norm)
A high need among vulnerable populations
Criteria that can be used to evaluate which health issues should be prioritized
include:
The community’s capacity to act on the issue, including any economic, social,
cultural, or political considerations
The likelihood or feasibility of having a measurable impact on the issue
Community resources (programs, funding) already focused on an issue
(to reduce duplication of effort and to maximize effectiveness of limited
resources)
Whether the issue is a root cause of other problems
(thereby possibly affecting multiple issues)
Consider a comprehensive intervention plan that includes multiple strategies
(educational, policy, environmental, programmatic); uses various settings for the
implementation (hospital, schools, worksites); targets the community at large as
well as subgroups; and addresses factors that contribute to the health priority. Be
sure to document and monitor results over the next one to three years to assure
that community needs identified within the assessment are being addressed.
Maintain records of assessment processes and priorities for obtaining base line
information and for pursuing ongoing process improvements. (Adapted from
materials by the Association for Community Health Improvement)
Once priorities have been established, set aside time to
develop, implement and monitor an action plan
that assesses progress
If you don’t help your community to thrive and grow,
how will your organization thrive and grow?
NATIONAL RURAL HEALTH RESOURCE CENTER 23
IMPROVING POPULATION HEALTH IN YOUR COMMUNITY
The U.S. health care industry is undergoing profound change in financing and
service delivery, as it shifts from a financial system that rewards “volume” to one
that is based on “value”. Driven by the health marketplace itself, the new health
industry goals are articulated in the Institute for Health Improvement’s Triple Aim:
better population health, better health quality and lower health costs. Payers are
increasingly factoring in population health outcomes into reimbursement formulas.
Population Health Portal
Navigate the journey towards improved population health by accessing a Critical
Access Hospital Readiness Assessment, resources and educational modules that
offer step-by-step instructions of common population health analytical procedures.
Small Rural Hospital Transition Guides and Toolkit
Informational guides developed by field experts and a toolkit developed by Rural
Health Innovations that concentrates on best practices and strategies to support
small rural hospital performance improvement and preparation for transitioning to
value-based care and purchasing.
NATIONAL RURAL HEALTH RESOURCE CENTER 24
Critical Population Health Success Factors
The following section summarizes the 2014 “Improving Population Health: A Guide
for Critical Access Hospitals”, created by The Center and Stratis Health.
Leadership
Develop awareness and provide education on the critical role of population
health in value-based reimbursement
Shift hospital culture, processes, facilities and business models to include a
focus on population health
Lead the way and model behaviors. Participate in programs, be active in
community outreach
Strategic Planning
Incorporate population health approaches as part of ongoing strategic
planning processes
Engage multiple stakeholders and partners to coordinate strategies aimed at
improving the population's health
Prioritize – what are the one or two things that would make the biggest
difference for the population you serve
Engagement
• Use the community health needs assessment (CHNA) process as an
opportunity for community and patient engagement
• Articulate vision of hospital contributing to population health based on
community conversations
• Engage all types of health care and social service providers to coordinate
transitions of care and address underlying needs
Leadership
• Develop awareness and provide education on the critical role of population
health in value-based reimbursement
• Shift hospital culture, processes, facilities and business models to include a
focus on population health
• Lead the way and model behaviors. Participate in programs, be active in
community outreach
Workforce
• Establish wellness programs for employees and role model these programs in
the community
• Develop a workforce culture that is adaptable to change in redesigning care
to address population health
NATIONAL RURAL HEALTH RESOURCE CENTER 25
• Embed a community focused mind-set across the organization so
engagement, coordination and cooperation are expectations of staff
interaction
Operations and Efficiency
• Maximize the efficiency of operational, clinical, and business processes under
current payment structures
• Utilize health information technology (HIT) (such as electronic medical
records, health information exchange and telemedicine) to support
population health goals
Measurement, Feedback & Knowledge Management, Impact & Outcomes
• Identify measurable goals that reflect community needs
• Utilize data to monitor progress towards strategic goals on population health
• Publicly share goals, data and outcomes. Use it as an opportunity to engage
partners and the community
NATIONAL RURAL HEALTH RESOURCE CENTER 26
POPULATION HEALTH CRITICAL ACCESS HOSPITAL CASE STUDIES
Leadership
Clearwater Valley Hospital in Idaho is utilizing a dyad management model which is
a two-pronged approach to physician/hospital integration. This model places the
organization’s leadership under the management of qualified physician and non-
physician teams aimed to incorporate the concept of value into health care
decision-making where departments have been restructured to meet patient needs
in both the inpatient and outpatient settings. This facility has received multiple
awards for incorporating this management model. For more information:
http://healthandwelfare.idaho.gov/Portals/0/Health/Rural%20Health/Orofino%20Ca
se%20Study%20November%202011.pdf
Strategic Planning
Essentia Health Fosston in Minnesota incorporated community health needs
assessment findings to improve the health of the community toward retaining a
quality and viable agricultural industry. For more information:
http://www.ruralcenter.org/tasc/resources/applying-community-health-
assessments-rural-hospital-strategy
Partners, Patients, Community
The Community Connector Program was established by Tri County Rural Health
Network in Helena, Arkansas which aims to increase access to home and
community-based services by creating alternatives to institutionalized living and
improving the quality of life for elderly and adults with physical disabilities while
maintaining or decreasing costs. The return on investment was $3 of every $1
invested, or a 23.8 percent average reduction in annual Medicaid spending per
participant, for a total reduction in spending of $2.619 million over three years. For
more information:
http://cph.uiowa.edu/ruralhealthvalue/innovations/Profiles/CommunityConnectors.p
df
NATIONAL RURAL HEALTH RESOURCE CENTER 27
Workforce and Culture
Mason District Hospital in Illinois is implementing a three tiered approach to a
worksite wellness program which includes a care coordination plan for employees
with multiple chronic illnesses. After two years, the hospital has seen nearly
$360,000 in reduced employee health care costs and has started offering the
program to local businesses which both improves health locally and provides an
additional revenue stream for the program. For more information:
http://www.icahn.org/files/White_Papers/ICAHN_PopHealthManagement_Print_FIN
AL.pdf (page 19)
Operations and Efficiency
Mercy Health Network in Iowa has adopted a Process Excellence tool modeled after
Lean to improve operations, efficiency and patient safety. Each hospital in the
network was assigned accountabilities, selected process improvements and helped
educate the hospital board. After 18 months, process improvements results in a 51
percent decrease in patient falls and a 37 percent decrease in medical errors. For
more information:
http://cph.uiowa.edu/ruralhealthvalue/innovations/Profiles/MercyHealthNetwork.pdf
Measurement, Feedback, & Knowledge Management, Impact & Outcomes
Marcum & Wallace Memorial Hospital in Hazard, Kentucky has adopted the
Performance Excellence Blueprint as indicators for their system (Catholic Health
Partnership) strategies. Leadership developed a dashboard to track program
towards targets in each of the seven Performance Excellence Components. For
more information:
https://ruralcenter.org/tasc/resources/marcum-wallace-memorial-hospital-
performance-excellence
NATIONAL RURAL HEALTH RESOURCE CENTER 31
APPENDIX B
Community Health Needs Assessment “Other” Survey comments
2. What are the three most pressing health concerns in the community?
Drugs (2)
Advanced emergency care
In-network providers
NIHL hearing loss
3. What is the greatest health education need in our community?
Substance abuse
Drug rehab
Hearing loss prevention
4. What is your preferred method to receive education on health issues through
Cordova Community Medical Center (CCMC)?
Word of mouth
Support groups
Doc Talk at CCMC
Health fair
5. What can Cordova Community Medical Center do to best meet the health needs
of our community?
(N = 82)
Staffing (25)
o Consistent staff (8)
o Keep staff long-term (3), too much turnover
o Hire doctors that will stick around (4)
o Keep more doctors in staff (2)
o Keep doctors long enough for folks to have an established relationship
with a doctor they know and trust. (2)
o Better doctors (2)
o Hire local employees (2) to show support of local community
o Try to maintain continuity of care (2)
Cost (15)
o Be cost effective/Reduce costs (7)
o Affordable health care (3)
o Lower cost by being in-network provider (2)
o Timely billing
o Sliding fee scale or payment plan that allows long period repayment
NATIONAL RURAL HEALTH RESOURCE CENTER 32
o Become a preferred provide for federal employee health insurance
plans (federal BCBS). This will lower costs for tests and encourage
local use rather than travel to Anchorage.
Education (10)
o More educational meetings with lots of publicity so people with that
particular interest or problem know it’s being presented (2)
o Once a month community meetings to educate on healthy lifestyle (2)
o More promotion of mammogram / prostate screenings, too often hear
about it after it’s open
o Reproductive health education
o Continue to inform citizens
o Education
o Community outreach programs
o Teach healthy eating practices and stay away from processed foods
Specialist Care (10)
o On-site specialist physician services (2)
o Bring specialists in monthly
o Networking to get more specialty care to come service Cordova
o Having specialist available in person or by phone 24/7
o Offer hearing services and affordable hearing equipment
o Create easy access to behavioral/mental health services (2)
o Substance abuse treatment program
o Offer more drug rehab to the kids in need and continue the pediatrics
care for the young ones
Labor and delivery services (7)
Good job (7)
o Keep up the good work (3)
o They are doing pretty great (3)
o Fantastic with CAT scan
Equipment (6)
o Upgrade health care utilities/equipment (4)
o Get more equipment for health emergencies
o Keep the ER stocked so you don’t have to run around and find supplies
ER (4)
o Provide ER (2)
o Ensure good ER treatment
o Keep ER open, close the CCMC clinic. We already have a clinic in town.
There’s no need for two clinics costing this city more money. Keep
Ilanka CHC open.
Quality (3)
o More professional, confidential services
o Follow-up communication of tests and labs
NATIONAL RURAL HEALTH RESOURCE CENTER 33
o Remember that visits to the hospital can cost [patients] several
hundred dollars per hour, and for that kind of money people should be
treated with the utmost respect and given good service.
Join with Ilanka (2)
Continue senior care and lunch program
Downsize facility to save money to keep doors open
Surveys like this one, questionnaires after visits
Remain open. Provide primary medical or mental health care
Open on Saturdays in the summer for fishing season
Local treatment, fewer medivacs
Remove City Council members from oversight roles
6. Where are you MOST likely to go for routine health care?
ANC (2)
Anchorage (3)
7. If you use primary care outside of CCMC, why?
Specialist care not available (7)
Availability (3)
Alaskan native beneficiary (3)
IHS (2)
Consistency of staff presence (2)
Too much turnover
Natural health clinic
Personal preference
Established provider/patient relationship
ANMC
Doctors tend to move to other areas – hard to develop a relationship
8. Which CCMC services have you used in the past three years?
None (4)
New to community
Health fair
Infusion
All for family not for myself
10. What type of specialist would you like to have access to MOST in our
community?
Pediatrics (3)
Not sure
Public health nurse
[selected OB/GYN] Having babies in Cordova would be very popular, and
save one month of waiting in Anchorage with hotel/food/no work for families
NATIONAL RURAL HEALTH RESOURCE CENTER 34
APPENDIX C: KEY INFORMANT INVITATION AND QUESTIONS
November 14, 2016
Greetings [Name]
Please accept this invitation to participate in a key informant interview
conducted by the National Rural Health Resource Center on behalf of Cordova
Community Medical Center (CCMC). The purpose of this one-on-one interview will
be to identify strengths and needs of community health for the region.
This information will be used for strategic planning, grant applications, new
programs and by community groups interested in addressing health issues. This
process was developed to maintain quality health care to serve the continuing and
future needs of the community.
You have been identified as a leader in the Cordova community and we
would like to hear from you about your perspectives on the health of the
community. Whether you or a family member are involved with local health care
services or not, this is your opportunity to help guide responsive, high quality local
health services in the future.
We invite you to participate in a 15-30 minute one-on-one phone interview with
[Sally/Kami] during one of the following timeframes:
X
X
X
Your help is very much appreciated in this effort. Please confirm your willingness
to participate by contacting Bridget Hart at [email protected] or 1-800-997-
6685, Ext. 239 to set up a time that works best for your schedule.
No identifiable information will be disclosed and individual responses will be kept
confidential.
We look forward to your participation. Thank you for your time.
Sincerely,
Kami Norland, Community Program Manager
National Rural Health Resource Center
NATIONAL RURAL HEALTH RESOURCE CENTER 35
Key Informant Questions
The questions below are the types of questions that will be asked during the key
informant interview. The purpose of this interview is to identify the strengths and
needs of health services in your community. No identifiable information will be
disclosed and the results will assist the health care organization with future care
and planning.
Describe the overall health of this community.
What is the greatest health need in the community?
What do you think the Hospital could do to increase the health of the
community? Where are the opportunities to collaborate?
In your opinion, what are some of the strengths (availability, quality) of the
health services offered at CCMC?
In your opinion, what are some of the barriers of the health services available
at CCMC?
What new health care services would you like to see available locally?
Why might people leave the community for health care?
What are some of the benefits of having health services available locally?